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Grief, Loss,Death And Dying


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Grief, Loss,Death And Dying

  1. 1. Mariane T. Sibala, RN Larmen de Guia Memorial College 2009
  2. 2. <ul><li>Loss is a universal experience that occurs throughout the lifespan. </li></ul><ul><li>Grief is a form of sorrow involving feelings, thoughts and behaviors caused by bereavement. </li></ul><ul><li>Responses to loss are strongly influenced by one’s cultural background. </li></ul>
  3. 3. <ul><li>The grief process involves a sequence of affective, cognitive and psychological states as a person responds to and finally accepts a loss. </li></ul>
  4. 4. <ul><li>LOSS = something of value is gone </li></ul><ul><li>GRIEF = total response to emotional experience related to loss </li></ul><ul><li>BEREAVEMENT = subjective response to by loved ones </li></ul><ul><li>MOURNING = behavioral response </li></ul>
  5. 5. Stages Behaviors D A B D A Refuses to believe that loss is happening Retaliation Feelings of Guilt, punishment for sins Laments over what has happened Begins to plan (e.g. wills, prosthesis)
  6. 6. <ul><li>The end of life </li></ul><ul><li>The full cessation of vital actions </li></ul><ul><li>Permanent state in the field of biology </li></ul><ul><li>All living things eventually die </li></ul><ul><li>What are the person’s feelings towards death? </li></ul>
  7. 7. <ul><li>Present generation may be unaware of feelings </li></ul><ul><li>Prolonging life </li></ul><ul><li>Common fears </li></ul><ul><li>Behaviors of health care professionals </li></ul>
  8. 8. <ul><li>“ No, not me…” </li></ul><ul><li>After the initial shock has worn off, the next stage is usually one of classic denial, where they pretend that the news has not been given. </li></ul><ul><li>They effectively close their eyes to any evidence and pretend that nothing has happened. </li></ul>
  9. 9. <ul><li>Do not interfere unless it becomes destructive </li></ul><ul><li>Do not support denial; conversations should include reality </li></ul><ul><li>Continue to teach and encourage self care activities. </li></ul>
  10. 10. <ul><li>“ Why me?” </li></ul><ul><li>This stage often occurs in an explosion of emotion, where the bottled –up feelings of the previous stages are expulsed in a huge outpouring of grief. </li></ul><ul><li>Whoever is in the way is likely to be blamed. </li></ul>
  11. 11. <ul><li>Give space allowing them to rail and below. The more the storm blows the sooner it will blow itself out. </li></ul><ul><li>Try not to respond in “kind” </li></ul><ul><li>When anger is destructive , it must be addressed directly. Remind the person of appropriate and inappropriate behavior. </li></ul>
  12. 12. <ul><li>“ Yes me, but…” </li></ul><ul><li>The patient attempts to negotiate a postponement with God and is generally kept a secret. </li></ul>
  13. 13. <ul><li>Spend time with patients </li></ul><ul><li>Discuss importance of valued objects and people. </li></ul>
  14. 14. <ul><li>The inevitability of the news eventually (and not before time) sinks in and the person reluctantly accepts that it is going to happen. </li></ul>
  15. 15. <ul><li>Be available </li></ul><ul><li>Don’t attempt to cheer person up </li></ul><ul><li>Find out any religious support </li></ul>
  16. 16. <ul><li>Restful time, but not necessarily happy. </li></ul><ul><li>Often begin putting their life in order, sorting out wills and helping others to accept the inevitability. </li></ul>
  17. 17. <ul><li>Plan care to allow the person with whom patient is comfortable to care for him or her </li></ul><ul><li>It is important that you don’t withdraw </li></ul>
  18. 18. <ul><li>May have increased hallucinations </li></ul><ul><li>Decreased appetite </li></ul><ul><li>May have temperature spikes </li></ul><ul><li>Incontinent for stool and urine 24 to 72 hours prior to death </li></ul><ul><li>Pain may be more intense </li></ul><ul><li>Restlessness is common 12 to 24 hours prior to death </li></ul>
  19. 19. <ul><li>Changes in respiratory status </li></ul><ul><li>Increase in chest fluids </li></ul><ul><li>Grunting and moaning on expiration </li></ul><ul><li>Skin changes </li></ul>
  20. 20. <ul><li>The role of the nursing staff is fundamentally supportive </li></ul><ul><li>Accept the physical and mental state he is in </li></ul><ul><li>Show him that they will not abandon him </li></ul><ul><li>Responds to the persons needs in a physical, psychological, social and intellectual level </li></ul>
  21. 21. <ul><li>Biological needs, reduction and control of pain </li></ul><ul><li>Pain is a subjective experience </li></ul><ul><li>Acute pain: usually temporary </li></ul><ul><li>Chronic pain: interrupts normal everyday functioning </li></ul><ul><li>Medication is more effective in the context of a holistic intervention </li></ul>
  22. 22. <ul><li>Feelings of anger, sadness, depression are part of a wider process of “anticipatory grief”, useful for the patient’s psychological preparation to die </li></ul><ul><li>Nursing staff has to comprehend and the person to express these feelings </li></ul><ul><li>The only way for the person to reconcile with these feelings is to talk to someone who is willing to listen </li></ul><ul><li>Support has to respond to the person’s need for safety, autonomy and self-control </li></ul>
  23. 23. <ul><li>Emotional and social withdrawal </li></ul><ul><li>Need of emotional withdrawal co-exists with the need of belonging to an accepting and supportive social environment </li></ul><ul><li>When family/medical nursing staff keep their distance in order to protect themselves, the person experiences a “social death”, which is sometimes more painful than the actual death </li></ul><ul><li>Nursing staff must treat the dying person without fear, encourage relatives to be close to him, act as a liaison with the outside world </li></ul>
  24. 24. <ul><li>The new reality: irrational, unfair, difficult </li></ul><ul><li>“ why” </li></ul><ul><li>Need to evaluate his life as meaningful, important, useful </li></ul><ul><li>Nursing staff should stand by him without being judgmental, let him decide where he wants to spend his last days, and interact with him as a person who LIVES </li></ul>
  25. 25. <ul><li>Nurses need to take time to analyze their own feelings about death before they can effectively help others with terminal illness </li></ul><ul><li>Understand that you may experience grief </li></ul><ul><li>Nurses have to be strong to control their feelings to be able to tolerate pain, illness, and death, and to keep their distance </li></ul>
  26. 26. <ul><li>Provide relief from illness , fear and depression </li></ul><ul><li>Help clients maintain sense of security </li></ul><ul><li>Help accept losses </li></ul><ul><li>Provide physical comfort </li></ul>
  27. 27. <ul><li>1-5 immobility and inactivity; wishes and unrelated action responsible for action </li></ul><ul><li>5-10 final but can be avoided </li></ul><ul><li>9-12 understands own mortality and fears death </li></ul><ul><li>12-18 fears and fantasizes avoidance </li></ul><ul><li>18- 45 increased attitude awareness </li></ul><ul><li>45-65 accepts mortality </li></ul><ul><li>Above 65 multiple meanings; encounters and fears </li></ul>